Each year Rural Health, Inc. has a special price on cholesterol screening tests during the month of March.  This is a service offered to increase attention to this very dangerous blood component which causes 20% of the 700,000 heart disease fatalities in our nation each year.   The Highmore and Murdo Clinics will do screening cholesterol tests the week of  March 10-14, 2003.   The Gettysburg Clinic will have their screening week  March 17 to March 21, 2003.  The Onida Clinic will announce their time later this month.

    The nature of cholesterol and its relation to heart disease was observed as long ago as 1872, more than 130 years ago.  As often happens, quirks of nature in which a person is born with a genetic birth defect can be very instructive.  In 1872, cases were published in one of the medical journals describing a family in which several siblings had fatty deposits on their elbows and their knuckles.  The siblings were observed to die suddenly at a young age.  Over the next 10-20 years, multiple other similar families were described in various countries in Europe.  This disease eventually became known as familial hypercholesterolemia.  The word “familial” implied that the condition was hereditary.  The prefix “hyper” means too much of something.  The ending “–emia” refers to “in the blood”. Thus familial hypercholesterolemia implied an hereditary condition that resulted in too much cholesterol in the blood.  Note that cholesterol is an essential component of the cell wall and various other structures in a normal living cell.  Cholesterol by itself is not bad.  It is only when the amount of cholesterol in the blood becomes too high that heart disease develops.

     To return to our story of familial hypercholesterolemia, it was discovered by Dr. Goldstein & Brown in 1972 that individuals with familial hypercholesterolemia lacked the cell surface receptor allowing the person to bring cholesterol into the cell.  Somehow this resulted in very high blood cholesterol levels and it was seen that these very high blood cholesterol levels were associated with premature heart disease.  There are descriptions of teenagers dying of heart attacks in these families.

     The heart disease epidemic in the United States really evolved from 1900 to about 1950.  During this time it became obvious that there were a large number of people in the United States dying of heart attacks.  The initial suspicion about the relationship of cholesterol to heart disease derived from the observations of familial hypercholesterolemia the century before.  Scientists reasoned that if high blood cholesterols in a familial disease could cause heart attacks then perhaps high blood cholesterols in the general public might also be related to heart attacks even though very few members of the general public had familial hypercholesterolemia.

     Indeed, data collected through the Framingham Heart Study begun in the 1950’s soon confirmed the impression that high blood cholesterols were tightly associated with an increase incidence of atherosclerotic disease causing heart attacks, strokes and peripheral vascular disease in which the arteries in the legs became clogged.  By the late 1960’s, the first drugs to treat high blood cholesterol were on the market.  However, these drugs failed to have a life saving impact.

     It wasn’t until 1988, that the first “statin’ drug was released on the market as Mevacor.  Since then Zocor, Pravachol, Lipitor, and Lescol have been other “statin” drugs that were released on the market and remain today.  Some may remember a drug called Baycol that was withdrawn from the market because of side effect problems.  All of the “statin” drugs work by decreasing the rate that the liver can make cholesterol.

     Today, a standard lipid panel has four components . The first component listed is the total blood cholesterol level.  Ideally, this is 200 mg% or less.  If the value is 240 mg% or more there is an increasing incidence of coronary artery disease and associated heart attacks.

     The second component listed on a lipid panel is an HDL (or high density lipoprotein).  This is the so called good cholesterol.  It was soon learned that higher blood levels of this type of cholesterol were associated with fewer heart attacks or strokes; very high blood levels of this protein are associated with longevity.  As one might imagine, there are medical efforts put forward to raise the blood level of this protein although thus far efforts have met with meager success.

     The third component on a lipid panel is the triglyceride level.  Triglycerides can be thought of as carbohydrates (apples, potatoes, bread, pasta, sugar) that were consumed in the previous week but not burned as energy.  This unburned energy is then converted from sugars into triglycerides.  The triglycerides are stored in the fatty deposits around the body until they are needed.  Unfortunately for many people, the need for these fats seems to be very meager and obesity follows.

     The last component of the lipid profile is the LDL (or low density lipoprotein).  This is the evil culprit that is associated with coronary artery and brain artery atherosclerosis with associated strokes and heart attacks.  In the past, the amount of LDL cholesterol in the blood was calculated by measuring the other three components.  This was a very imprecise estimate of the actual LDL of the blood.  More recently, the so called “direct LDL” test has become available in Rural Health, Inc. clinics instead of the old inaccurate method.

     Thus, the standard lipid profile has four components as mentioned:  1.  The total cholesterol which should be less than 200 mg%.   2.  The HDL cholesterol which is ideally 45 mg % or more.  3.  The triglyceride level which ideally is 150 mg % or less and lastly, 4.  The LDL cholesterol which ideally is 100 mg % or less.

     In next week’s column, particulars on the use of this lipid panel and how Medicare and insurance companies are going to reimburse for having these tests done will be discussed in addition to certain patterns of lipid abnormalities and the appropriate medications to take of these.  Go to your local clinics the week of  March 10 or March 17 and see what you cholesterol is.